Provider Demographics
NPI:1588120687
Name:WASHINGTON, JOHN KYLE (TM)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KYLE
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 HAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3118
Mailing Address - Country:US
Mailing Address - Phone:617-959-0860
Mailing Address - Fax:
Practice Address - Street 1:97 HAWLEY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3118
Practice Address - Country:US
Practice Address - Phone:617-959-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health